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General NPI Number Information
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NPI Number | 1720360928
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Entity Type | Individual
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Provider Name | BRET LOUIS TABER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 13123 E 16TH AVE
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City | AURORA
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State | CO
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Zip | 80045-7106
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Country | US
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Telephone | 720-453-9543
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Fax |
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Provider Business Mailing Address
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Address Line | 1839 CLERMONT ST
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City | DENVER
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State | CO
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Zip | 80220-1111
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Country | US
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Telephone | 720-453-9543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA21611
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.0005300
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License Number State | CO
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